Provider Demographics
NPI:1437344108
Name:HAROLD E REAVES M.D.,INC
Entity Type:Organization
Organization Name:HAROLD E REAVES M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-481-3937
Mailing Address - Street 1:420 E 3RD ST STE 603
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1645
Mailing Address - Country:US
Mailing Address - Phone:213-680-1551
Mailing Address - Fax:213-680-2148
Practice Address - Street 1:420 E 3RD ST STE 603
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1645
Practice Address - Country:US
Practice Address - Phone:213-680-1551
Practice Address - Fax:213-680-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G338350Medicaid
CAA91543Medicare UPIN
CA00G338350Medicaid
CABP068AMedicare PIN